Multidisciplinary integrated parent and child centres in Amsterdam: a qualitative study

Background: In several countries centres for the integrated delivery of services to the parent and child have been established. In the Netherlands family health care service centres, called Parent and Child Centres (PCCs) involve multidisciplinary teams. Here doctors, nurses, midwives, maternity help professionals and educationists are integrated into multidisciplinary teams in neighbourhood-based centres. To date there has been little research on the implementation of service delivery in these centres. Study Design: A SWOT analysis was performed by use of triangulation data; this took place by integrating all relevant published documents on the origin and organization of the PCCs and the results from interviews with PCC experts and with PCC professionals (N=91). Structured interviews were performed with PCC-professionals (health care professionals (N=67) and PCC managers N=12)) and PCC-experts (N=12) in Amsterdam and qualitatively analysed thematically. The interview themes were based on a pre-set list of codes, derived from a prior documentation study and a focus group with PCC experts. Results: Perceived advantages of PCCs were more continuity of care, shorter communication lines, low-threshold contact between professionals and promising future perspectives. Perceived challenges included the absence of uniform multidisciplinary guidelines, delays in communication with hospitals and midwives, inappropriate accommodation for effective professional integration, differing expectations regarding the PCC-manager role among PCC-partners and the danger of professionals' needs dominating clients' needs. Conclusions: Professionals perceive PCCs as a promising development in the integration of services. Remaining challenges involved improvements at the managerial and organizational level. Quantitative research into the improvements in quality of care and child health is recommended

Nationwide population-based cohort study of uterine rupture in Belgium : results from the Belgian Obstetric Surveillance System

Objectives: We aimed to assess the prevalence of uterine rupture in Belgium and to evaluate risk factors, management and outcomes for mother and child. Design: Nationwide population-based prospective cohort study. Setting: Emergency obstetric care. Participation of 97% of maternity units covering 98.6% of the deliveries in Belgium. Participants: All women with uterine rupture in Belgium between January 2012 and December 2013. 8 women were excluded because data collection forms were not returned. Results: Data on 90 cases of confirmed uterine rupture were obtained, of which 73 had a previous Caesarean section (CS), representing an estimated prevalence of 3.6 (95% CI 2.9 to 4.4) per 10000 deliveries overall and of 27 (95% CI 21 to 33) and 0.7 (95% CI 0.4 to 1.2) per 10000 deliveries in women with and without previous CS, respectively. Rupture occurred during trial of labour after caesarean section (TOLAC) in 57 women (81.4%, 95% CI 68% to 88%), with a high rate of augmented (38.5%) and induced (29.8%) labour. All patients who underwent induction of labour had an unfavourable cervix at start of induction (Bishop Score 7 in 100%). Other uterine surgery was reported in the history of 22 cases (24%, 95% CI 17% to 34%), including 1 case of myomectomy, 3 cases of salpingectomy and 2 cases of hysteroscopic resection of a uterine septum. 14 cases ruptured in the absence of labour (15.6%, 95% CI 9.5% to 24.7%). No mothers died; 8 required hysterectomy (8.9%, 95% CI 4.6% to 16.6%). There were 10 perinatal deaths (perinatal mortality rate 117/1000 births, 95% CI 60 to 203) and perinatal asphyxia was observed in 29 infants (34.5%, 95% CI 25.2% to 45.1%). Conclusions: The prevalence of uterine rupture in Belgium is similar to that in other Western countries. There is scope for improvement through the implementation of nationally adopted guidelines on TOLAC, to prevent use of unsafe procedures, and thereby reduce avoidable morbidity and mortality

Buitenklimaatstal: goedkope ruwbouw en energiebesparing

De Nederlandse varkenshouder wordt steeds vaker geconfronteerd met de productie en import van vlees uit andere landen. Een concurrerende kostprijs is daarom belangrijk. Dit kan bijvoorbeeld door bij nieuwbouw te kiezen voor een stal met goedkope ruwbouw

Wees zuinig met energie

Op varkensbedrijven is er een grote spreiding in energiegebruik. Dit wordt veroorzaakt door verschil in management en verschil in bedrijfsuitrusting. Er zijn er in de varkenshouderij veel mogelijkheden om duurzame energie toe te passen

Omineca Herald, October, 04, 1979

The relation between progression of cerebral small vessel disease (SVD) and gait decline is uncertain, and diffusion tensor imaging (DTI) studies on gait decline are lacking. We therefore investigated the longitudinal associations between (micro) structural brain changes and gait decline in SVD using DTI. 275 participants were included from the Radboud University Nijmegen Diffusion tensor and Magnetic resonance imaging Cohort (RUN DMC), a prospective cohort of participants with cerebral small vessel disease aged 50–85years. Gait (using GAITRite) and magnetic resonance imaging measures were assessed during baseline (2006–2007) and follow-up (2011−2012). Linear regression analysis was used to investigate the association between changes in conventional magnetic resonance and diffusion tensor imaging measures and gait decline. Tract-based spatial statistics analysis was used to investigate region-specific associations between changes in white matter integrity and gait decline. 56.2% were male, mean age was 62.9years (SD8.2), mean follow-up duration was 5.4years (SD0.2) and mean gait speed decline was 0.2m/s (SD0.2). Stride length decline was associated with white matter atrophy (β=0.16, p=0.007), and increase in mean white matter radial diffusivity and mean diffusivity, and decrease in mean fractional anisotropy (respectively, β=−0.14, p=0.009; β=−0.12, p=0.018; β=0.10, p=0.049), independent of age, sex, height, follow-up duration and baseline stride length. Tract-based spatial statistics analysis showed significant associations between stride length decline and fractional anisotropy decrease and mean diffusivity increase (primarily explained by radial diffusivity increase) in multiple white matter tracts, with the strongest associations found in the corpus callosum and corona radiata, independent of traditional small vessel disease markers. White matter atrophy and loss of white matter integrity are associated with gait decline in older adults with small vessel disease after 5years of follow-up. These findings suggest that progression of SVD might play an important role in gait decline. Keywords: Cerebral small vessel disease (SVD), MRI, Diffusion tensor imaging (DTI), Tract-based spatial statistics (TBSS), Gai

Standard survey methods for estimating colony losses and explanatory risk factors in Apis mellifera

This chapter addresses survey methodology and questionnaire design for the collection of data pertaining to estimation of honey bee colony loss rates and identification of risk factors for colony loss. Sources of error in surveys are described. Advantages and disadvantages of different random and non-random sampling strategies and different modes of data collection are presented to enable the researcher to make an informed choice. We discuss survey and questionnaire methodology in some detail, for the purpose of raising awareness of issues to be considered during the survey design stage in order to minimise error and bias in the results. Aspects of survey design are illustrated using surveys in Scotland. Part of a standardized questionnaire is given as a further example, developed by the COLOSS working group for Monitoring and Diagnosis. Approaches to data analysis are described, focussing on estimation of loss rates. Dutch monitoring data from 2012 were used for an example of a statistical analysis with the public domain R software. We demonstrate the estimation of the overall proportion of losses and corresponding confidence interval using a quasi-binomial model to account for extra-binomial variation. We also illustrate generalized linear model fitting when incorporating a single risk factor, and derivation of relevant confidence intervals

Molecular-level understanding of interfacial carbonates in stabilizing CuO-ZnO(Al2O3) catalysts

A descriptor of active CuO-ZnO(Al2O3) methanol-synthesis and water–gas-shift catalysts is the presence of high-temperature carbonates (HT-CO3) in the oxidic catalyst precursor. Previous reports have shown that such HT-CO3 lead to an appropriate interaction between the oxides; as a result, a high Cu surface area (or Cu-Zn or Cu/ZnO interphase areas) can be achieved. Yet, their nature is not well understood. In this study, the nature of these carbonates was investigated by experimental and theoretical methods in the oxidic precatalyst. A calcined Cu-Zn-Al hydrotalcite model compound revealed to have well-dispersed ZnO and CuO phases, together with highly stable HT-CO3. It was hypothesized that these HT-CO3 groups may be placed at critical locations at nano-scale as a glue, thus avoiding the growth of the oxide crystallites during calcination. This is an excellent pre-condition to achieve a high Cu surface area (or Cu-Zn or Cu/ZnO interphase areas) upon reduction, and therefore a high activity. To prove that, first-principles calculations were carried out based on the density functional theory (DFT); alumina was not considered in the model as the experimental data showed it to be amorphous but it may still have an effect. Comprehensive calculations provided evidence that such carbonate groups favourably bind the CuO and ZnO together at the interface, rather than being isolated on the individual oxide surfaces. The results strongly suggest that the HT-CO3 groups are part of the structure, in the calcined precatalyst, where they would prevent thermal sintering through a bonding mechanism between CuO and ZnO particles, which is a novel interpretation of this important catalyst descriptor

The analysis of European lacquer : optimization of thermochemolysis temperature of natural resins

In order to optimize chromatographic analysis of European lacquer, thermochemolysis temperature was evaluated for the analysis of natural resins. Five main ingredients of lacquer were studied: sandarac, mastic, colophony, Manila copal and Congo copal. For each, five temperature programs were tested: four fixed temperatures (350, 480, 550, 650 degrees C) and one ultrafast thermal desorption (UFD), in which the temperature rises from 350 to 660 degrees C in 1 min. In total, the integrated signals of 27 molecules, partially characterizing the five resins, were monitored to compare the different methods. A compromise between detection of compounds released at low temperatures and compounds formed at high temperatures was searched. 650 degrees C is too high for both groups, 350 degrees C is best for the first, and 550 degrees C for the second. Fixed temperatures of 480 degrees C or UFD proved to be a consensus in order to detect most marker molecules. UFD was slightly better for the molecules released at low temperatures, while 480 degrees C showed best compounds formed at high temperatures

Anaphylaxis in pregnancy : a population-based multinational European study

Funding Information: M‐P B, OA, and GV had equal contributions to this study. We thank T. Schapp, J. Zwart and E. Overtoom in the NethOSS team; C. Daoui from the French SFAR Research Network; the B.OSS team and Belgian maternity units involved in this study. The work was funded by the Medical Research Council (MRC) and the Nuffield Department of Population Health. The views expressed in this publication are those of the authors and not necessarily those of the MRC. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the article. Permission for the use and sharing of registry and medical records was obtained from the National Institute for Health and Welfare (THL), Finland. Approval was acquired from the B.OSS and NethOSS steering committee for the data collection and sharing of anonymous data for this anaphylaxis study. The French Data Protection Authority approved the collection of the data (CNIL 1985389). All the women in France were informed of anonymised data collection during the study. B.oSS gained approval for data collection from the Ghent University Ethics Committee as central EC (2015/1470, amendment 23/06/2016, B670201526875), and gained informed consent of all women included in the study. The Central University Research Ethics Committee, University of Oxford gave approval to complete this prospective observational study (Reference R46400/RE001). Data sharing statement: Data cannot be shared publicly due to confidentiality issues arising from small numbers of cases in mainland European countries. Requests for access to the UK dataset will be considered by the National Perinatal Epidemiology Unit Data Sharing committee. Access to the data can be requested from [email protected] . No other external funding or competing interests declared. Publisher Copyright: © 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Peer reviewedPublisher PD

Auditory presentation and synchronization in Adobe Flash and HTML5/JavaScript Web experiments

Substantial recent research has examined the accuracy of presentation durations and response time measurements for visually presented stimuli in Web-based experiments, with a general conclusion that accuracy is acceptable for most kinds of experiments. However, many areas of behavioral research use auditory stimuli instead of, or in addition to, visual stimuli. Much less is known about auditory accuracy using standard Web-based testing procedures. We used a millisecond-accurate Black Box Toolkit to measure the actual durations of auditory stimuli and the synchronization of auditory and visual presentation onsets. We examined the distribution of timings for 100 presentations of auditory and visual stimuli across two computers with difference specs, three commonly used browsers, and code written in either Adobe Flash or JavaScript. We also examined different coding options for attempting to synchronize the auditory and visual onsets. Overall, we found that auditory durations were very consistent, but that the lags between visual and auditory onsets varied substantially across browsers and computer systems